Good outcome scores and high satisfaction rate after primary total ankle replacement

Abstract

Background and purpose — Total ankle replacement (TAR) is gaining popularity for treatment of end-stage ankle arthritis. Large patient-centered outcome studies are, however, few. Here, we report data from the Swedish Ankle Registry.Patients and methods — We examined outcomes after primary TAR in patients from the Swedish Ankle Registry using PROMs (Patient Reported Outcome Measures; generic: EQ-5D and SF-36, region specific: SEFAS (Self-Reported Foot and Ankle Score), and a question on satisfaction). We included 241 patients registered with primary TAR between 2008 and 2016 and who completed PROMs preoperatively and postoperatively up to 24 months. We evaluated changes in PROMs following surgery and estimated effects of age, diagnosis, prosthetic design, and preoperative functional score on the outcomes.Results — All absolute scores improved from preoperative to 24 months after surgery (p ≤ 0.001). 71% of the patients were satisfied or very satisfied at the latest follow-up and 12% dissatisfied or very dissatisfied. Postoperative SEFAS correlated with age (r = 0.2, p = 0.01) and preoperative SEFAS (r = 0.3, p < 0.001), as did patient satisfaction (r = −0.2; p ≤ 0.03). Postoperative SEFAS and EQ-5D were similar between different diagnoses or prosthetic designs. Preoperative SF-36 was associated with diagnosis (p ≤ 0.03), postoperative SF-36 with age (r = 0.2, p = 0.01) and diagnosis (p < 0.03).Interpretation — We found statistically and clinically significant improvements in patient-reported outcomes following TAR surgery. The postoperative region-specific SEFAS was positively associated with older age. Prosthetic design seemed not to influence patient-reported outcome, whereas diagnosis partly did. Studies with longer follow-up are necessary to establish the long-term outcome of TAR and to elucidate whether short- and mid-term outcomes may predict implant failure.

Collection and use of EQ-5D for follow-up, decision-making, and quality improvement in health care - the case of the Swedish National Quality Registries

“…For example, EQ-5D data from the National Quality Registry for Atrial Fibrillation and Anticoagulation (AuriculA) have been used in a study that aimed to assess the effectiveness and cost-effectiveness of a risk score-based treatment of patients with atrial fibrillation [32]. Furthermore, EQ-5D data from other registries have been used to assess the outcome of an osteoarthritis learning programme [33], biological treatment in psoriasis [34], pain rehabilitation [35], treatment of fractures [36], hip arthroplasty [37], shoulder arthroplasty [38], spine surgery [39], knee arthroplasty [30], foot surgery [40], and total ankle replacement [41,42]. In addition to AuriculA, four registries (SQRP, Swespine, MMCUP, and NREV) described ongoing collaborations with health economists to investigate the health economic aspects of the disease, or specific interventions.…”

Effect of Total Ankle Arthroplasty and Ankle Arthrodesis for Ankle Osteoarthritis: A Comparative Study

“…The first TAA outcomes, published in 1972, were unsatisfactory due to imperfect implants [9]. Over the following years many improvements were made, including new generations of implants, novel medical technologies and biomaterials, and a better understanding of ankle biomechanics [10,11].…”

Memorandum Register für die Versorgungsforschung: Update 2019

“…▪ Demgegenüber sind Medizinprodukteregister auf die Analyse und Bewertung von Medizinprodukten wie Implantaten ausgerichtet [3,24]. Die erfassten Patientengruppen können unterschiedliche Erkrankungen aufweisen [25], oder es können Medizinprodukte als Teil alternativer Versorgungsansätze einer Erkrankung betrachtet werden [26]. Zentrale Endpunkte solcher Register sind das Überleben der Patienten mit einem Medizinprodukt, das "Überleben" des Medizinproduktes selbst (Standzeit) [27], Komplikationen in Zusammenhang mit dem Einsetzen des Medizinprodukts oder mit dem Medizinprodukt sowie die Lebensqualität der Patienten und die Zufriedenheit der Patienten mit dem Medizinprodukt.…”